45 Neck Pain

trauma, degenerative changes, infection, and autoimmune disorders such as rheumatoid arthritis and ankylosing spondylitis. The perception and resultant reporting of this pain vary significantly according to cultural and social circumstances. Honeyman and Jacobs noted that Australian Aborigines significantly underreport pain and are rarely disabled by pain. Social circumstances also play an important role in an individual’s ability to cope with and overcome neck pain. Studies have demonstrated worse outcomes following dis­ kectomy for patients with a workers’ compensation claim or litigation surrounding their condition. These studies indi­ cate nonorganic contributions to neck pain for secondary gain. Fortunately, most episodes of acute neck pain resolve with “tincture of time” and patient education. Physicians need to be able to differentiate causes of neck pain that can be managed with a conservative approach from those that require more aggressive treatment. An understanding of anatomy and physiology and of their asso­ ciation with the pathogenesis of neck pain provides the basis for obtaining a thorough history, physical examination findings, and ancillary data with the ultimate goal of effec­ tive treatment.